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Purpose <p>The Spot Sign (SS) is a radiological finding on computed tomography angiography (CTA) in patients with intracerebral hemorrhage (ICH). This meta-analysis aimed to evaluate the association between the SS and both hematoma expansion (HE) and functional outcomes by comparing ICH patients with and without SS.</p> Methods <p>We searched PubMed, Embase and Cochrane Library for studies of intracranial hemorrhage reporting the SS. The primary outcomes examined were functional status and hematoma expansion, secondary outcomes were mortality and initial hematoma volume. Statistical analysis was performed using RStudio (version 4.5.2), and heterogeneity was assessed with I² statistics. In addition, sensitivity analyses were performed, and publication bias was assessed through funnel plots and Egger’s regression test.</p> Results <p>We included 10 observational studies with a total of 2,832 patients with spontaneous ICH. Of these, 613 had SS, while 2,219 did not. The mean age was 66.31 ± 13.81 and 1,367 (58.6%) were male. Poor functional outcomes (OR 4.06, 95% CI 2.66─6.20, <i>p</i> &lt; 0.0001, I² = 0.0%) and hematoma expansion (OR 7.17, 95% CI: 5.65─9.09, <i>p</i> &lt; 0.0001, I² = 0.0%) were substantially higher in patients with SS, as well as the overall mortality rate (OR 4.14, 95% CI 2.45–6.99, <i>p</i> &lt; 0.0001, I² = 65.4%). However, the initial hematoma volume (MD 11.54, 95% CI -11.43─34.52, <i>p</i> = 0.2082, I² = 80.1%) was not statistically different between groups. Furthermore, the leave-one-out sensitivity analyses showed that no single study exerted a disproportionate influence on the overall effect for the examined outcomes, and Egger’s linear regression tests were not statistically significant for both primary outcomes.</p> Conclusion <p>The presence of the SS is associated with higher rates of poor functional outcomes and hematoma expansion. Therefore, the SS represents a relevant radiological marker with potential to support early risk stratification and optimize patient management and treatment selection.</p> Graphical abstract <p></p>

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Spot sign as a predictor of hematoma expansion and poor functional outcomes after intracerebral hemorrhage: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Maria Clara Nery Cardoso,
  • Davi Chaves Rocha de Souza,
  • Bruna Rios Beserra,
  • Theo Cardoso Ribeiro,
  • Vinicius Rodrigues Oliveira Alves,
  • Amanda Cerqueira Marcolino,
  • Maria Fernanda Nery Cardoso

摘要

Purpose

The Spot Sign (SS) is a radiological finding on computed tomography angiography (CTA) in patients with intracerebral hemorrhage (ICH). This meta-analysis aimed to evaluate the association between the SS and both hematoma expansion (HE) and functional outcomes by comparing ICH patients with and without SS.

Methods

We searched PubMed, Embase and Cochrane Library for studies of intracranial hemorrhage reporting the SS. The primary outcomes examined were functional status and hematoma expansion, secondary outcomes were mortality and initial hematoma volume. Statistical analysis was performed using RStudio (version 4.5.2), and heterogeneity was assessed with I² statistics. In addition, sensitivity analyses were performed, and publication bias was assessed through funnel plots and Egger’s regression test.

Results

We included 10 observational studies with a total of 2,832 patients with spontaneous ICH. Of these, 613 had SS, while 2,219 did not. The mean age was 66.31 ± 13.81 and 1,367 (58.6%) were male. Poor functional outcomes (OR 4.06, 95% CI 2.66─6.20, p < 0.0001, I² = 0.0%) and hematoma expansion (OR 7.17, 95% CI: 5.65─9.09, p < 0.0001, I² = 0.0%) were substantially higher in patients with SS, as well as the overall mortality rate (OR 4.14, 95% CI 2.45–6.99, p < 0.0001, I² = 65.4%). However, the initial hematoma volume (MD 11.54, 95% CI -11.43─34.52, p = 0.2082, I² = 80.1%) was not statistically different between groups. Furthermore, the leave-one-out sensitivity analyses showed that no single study exerted a disproportionate influence on the overall effect for the examined outcomes, and Egger’s linear regression tests were not statistically significant for both primary outcomes.

Conclusion

The presence of the SS is associated with higher rates of poor functional outcomes and hematoma expansion. Therefore, the SS represents a relevant radiological marker with potential to support early risk stratification and optimize patient management and treatment selection.

Graphical abstract